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1095-C Employer-Provided Health Insurance Offer and Coverage Continuation Form (100 Sheets/Pack)

Item Number: 1095CC25

Pricing:

Price per Pack of 100 Sheets	2+ Packs	5+ Packs	10+ Packs	20+ Packs
$57.53	$51.06	$47.13	$46.42	$45.72
Savings	11.2%	18.1%	19.3%	20.5%

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Description

2022 Employer Provided Health Insurance Offer and Coverage Continuation Forms, 100 per pack. This health coverage form shows whether or not the employer offered health coverage to employees. This form is for employers with 50 or more full-time employees. Both insured and self-insured issue 1095-C. 8-1/2" x11", Printed in Black ink. 100 sheets per pack

Specifications

Brand:	TFP Data Systems
Feature 1:	Laser cut sheets for Inkjet and Laser printers
Feature 2:	Ships in 4-5 business days
Carbonless:	No
Claim Type:	1095-C
Color:	White
Condition:	New
Currency:	USD
Holes Punched:	No
Pre-Printed:	Yes
Package Height:	11 in
Package Weight:	8.00 LB
Package Width:	8-1/2 in
Material:	Paper
Country of Origin:	USA
Manufacturer Part Number:	1095CC25
Number of Forms:	25
Number of Items:	200
Perforation:	No
Ships in:	4 to 5 Business Days (Plus time in transit)
Size:	8-1/2 x 11 in
Style:	Laser cut sheet
Text Color:	Black

1095-C Employer-Provided Health Insurance Offer and Coverage Continuation Form (100 Sheets/Pack)

Item Number: 1095CC25

Pricing:

Site Information:

855-632-8520